Abstract

Background Upper gastrointestinal (UGI) endoscopy is a routine healthcare procedure with a defined patient pathway. The objective of
this study was to redesign this pathway for unsedated patients using lean thinking transformation to focus on patient-derived
value-adding steps, remove waste and create a more efficient process. This was to form the basis of a pathway template that
was transferrable to other endoscopy units.

Methods A literature search of patient expectations for UGI endoscopy identified patient-derived value. A value stream map was created
of the current pathway. The minimum and maximum time per step, bottlenecks and staff–staff interactions were recorded. This
information was used for service transformation using lean thinking. A patient pathway template was created and implemented
into a secondary unit. Questionnaire studies were performed to assess patient satisfaction.

Results In the primary unit the patient pathway reduced from 19 to 11 steps with a reduction in the maximum lead time from 375 to
80 min following lean thinking transformation. The minimum value/lead time ratio increased from 24% to 49%. The patient pathway
was redesigned as a ‘cellular’ system with minimised patient and staff travelling distances, waiting times, paperwork and
handoffs. Nursing staff requirements reduced by 25%. Patient-prioritised aspects of care were emphasised with increased patient–endoscopist
interaction time. The template was successfully introduced into a second unit with an overall positive patient satisfaction
rating of 95%.

Conclusion Lean thinking transformation of the unsedated UGI endoscopy pathway results in reduced waiting times, reduced staffing requirements
and improved patient flow and can form the basis of a pathway template which may be successfully transferred into alternative
endoscopy environments with high levels of patient satisfaction.

Footnotes

Competing interests None.

Ethics approval The study was reviewed by the Portsmouth and South East Hampshire Research Ethics Committee who granted approval as a service
evaluation, and for which formal ethical approval was therefore not required. The study and its results were reviewed and
accepted by the Clinical Governance Committee for Portsmouth Hospitals Trust.